Total Arterial Off-Pump Coronary Revascularization with Only Internal Thoracic Artery and Composite Radial Artery Grafts

2005 ◽  
Vol 6 (1) ◽  
pp. 30 ◽  
Author(s):  
Junjiro Kobayashi ◽  
Osamu Tagusari ◽  
Ko Bando ◽  
Kazuo Niwaya ◽  
Hiroyuki Nakajima ◽  
...  
Keyword(s):  
Radial Artery ◽  
Internal Thoracic Artery ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Graft Patency ◽  
Graft Occlusion ◽  
Angiographic Study ◽  
Actuarial Survival ◽  
Off Pump

<P>Objective: Total arterial off-pump coronary artery bypass (OPCAB) grafting with only internal thoracic artery (ITA) and composite radial artery (RA) grafts has been applied extensively to avoid cerebral complications and late vein graft failure. We evaluated the initial experience with this method by clinical and angiographic study. </P><P>Methods: Between April 2000 and May 2002, 257 patients underwent OPCAB grafting with this technique. The range of ages at operation was 42 to 86 years (mean, 66.1 � 8.6 years). On average, 3.28 � 0.86 grafts per patient were completed. More than 4 distal anastomoses were performed in 88 patients (34%). For coronary revascularization, 289 ITA and 555 RA grafts were used. The RA was used as a Y graft in 211 patients, as an I graft (for ITA extension) in 52 patients, and as a K graft (the side of the RA attached to the side of the left ITA) in 28 patients. Sequential bypass grafting was performed with 190 RA and 7 ITA grafts. The sites of distal anastomoses were 256 left anterior descending arteries (30%), 236 posterolateral branches (28%), 144 posterior descending arteries (17%), 106 diagonal branches (13%), 82 obtuse marginal branches (10%), and 19 right coronary arteries (2%). </P><P>Results: There were 1 operative death (0.4%) due to cerebral hemorrhage and 2 episodes of stroke (0.8%) during postoperative angiography. There were no clinical underperfusion syndromes or new intra-aortic balloon pump insertions. Perioperative myocardial infarction occurred in 12 patients (4.7%), sternal dehiscence in 5 (1.9%), and early coronary intervention in 4 (1.6%). There was no deep wound infection, reexploration for bleeding, or hand ischemia. The actuarial survival rate and the cardiac event-free rate at 2 years were 98.6% � 2.4% and 94.2% � 0.8%, respectively. Early postoperative angiography revealed a 97.8% (264/270) graft patency of ITAs and 97.9% (512/523) graft patency of RAs in 238 patients. Flow competition of the RA graft was recognized in 22 patients and, as indicated by follow-up angiographic study, did not cause late graft occlusion. </P><P>Conclusions: OPCAB grafting with ITAs and composite RAs provides excellent early and intermediate clinical results and graft patency.</P>

Clinical Outcomes after Hybrid Coronary Revascularization versus Off-Pump Coronary Artery Bypass

2009 ◽  
Vol 4 (6) ◽  
pp. 299-306 ◽  
Author(s):  
Thomas A. Vassiliades ◽  
Patrick D. Kilgo ◽  
John S. Douglas ◽  
Vasilis C. Babaliaros ◽  
Peter C. Block ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Left Internal Mammary Artery ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Off Pump ◽  
Internal Mammary ◽  
Hybrid Coronary Revascularization ◽  
Pump Coronary Artery Bypass ◽  
Hybrid Group

Objective Hybrid coronary revascularization is offered as an alternative strategy for patients with multivessel coronary artery disease (CAD). We present our experience and provide a comparative analysis to off-pump coronary artery bypass grafting (OPCAB). Methods Ninety-one patients with multivessel CAD underwent minimally invasive left internal mammary artery to left anterior descending grafting in combination with percutaneous coronary intervention of nonleft anterior descending targets (HYBRID). The primary end point of this study was major adverse cardiac and cerebrovascular events (MACCE), defined as death, stroke, and nonfatal myocardial infarction. MACCE in the HYBRID group were compared with 4175 contemporaneously performed OPCAB operations by logistic (30-day outcomes) and Cox proportional hazards (long-term survival) regression methods. Propensity scoring was used to adjust for potential selection bias. Results The 30-day MACCE (death/stroke/nonfatal myocardial infarction) rate was 1.1% for the HYBRID group (0%/0%/1.1%) and 3.0% for the OPCAB group (1.8%/1.1%/0.5%) (odds ratio = 0.47, P = 0.48). Angiographic left internal mammary artery evaluation was obtained in 95.6% of patients (87 of 91) revealing FitzGibbon A patency in 98.0% (96 of 98). The reintervention rate at 1 year for the HYBRID group was 5.5% (5 of 91) and was limited to repeat percutaneous coronary intervention. Three-year survival was statistically similar for the two groups (hazard ratio = 0.44, P = 0.18, see Kaplan-Meier figure). Conclusions Hybrid coronary revascularization may be noninferior to OPCAB with respect to early MACCE and 3-year survival in the treatment of multivessel CAD.

scholarly journals Intraoperative Assessment of Coronary Resistances: A New Quality Marker and Potential Tool to Predict Early Graft Failure after Coronary Artery Bypass Grafting?

2021 ◽  
Vol 8 (12) ◽  
pp. 163
Author(s):  
Antonino Salvatore Rubino ◽  
Fabrizio Ceresa ◽  
Liborio Mammana ◽  
Giuseppe Vite ◽  
Gianluca Cullurà ◽  
...  
Keyword(s):  
Graft Failure ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Graft Patency ◽  
Graft Occlusion ◽  
Additional Tool ◽  
Intraoperative Assessment ◽  
Early Graft ◽  
Early Graft Failure

Intraoperative assessment of graft patency is pivotal for successful coronary revascularization. In the present study we aimed to propose a new, easy to perform tool to assess anastomotic quality intraoperatively, and to investigate its potential reliability in predicting early graft failure. Intraoperative graft flowmetry of 63 consecutive patients undergoing CABG were prospectively collected. Transit time flowmetry and its derivatives were recorded. Coronary resistances were calculated according to Hagen–Poiseuille equation both during cardioplegic arrest and after withdrawal from cardiopulmonary bypass. Angiographic evidence of graft occlusion at follow-up was cross-checked with intraoperative recordings. After a mean follow-up of 10.4 ± 6.0 months, 22 grafts were studied, and occlusion was documented in five (22.7%). Occluded grafts showed lower flows and higher resistances recorded during aortic cross-clamping. Coronary resistances, recorded during aortic cross-clamping, greater than 2.0 mmHg/mL/min, showed a sensitivity of 80% and a specificity of 100% to predict graft failure. We propose the routine recording of coronary resistances during aortic cross-clamping as an additional tool to overcome the acknowledged limitation of TTF to predict graft occlusion at 1 year.

scholarly journals Does Early Graft Patency Benefit from Perioperative Statin Therapy? A Propensity Score-Matched Study of Patients Undergoing Off-Pump Coronary Artery Bypass Surgery

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Shanglin Chen ◽  
Hengchao Wu ◽  
Tao Yang ◽  
Baotong Li ◽  
Yuanyu Hu ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Statin Therapy ◽  
Odds Ratio ◽  
Artery Bypass ◽  
Graft Patency ◽  
Graft Occlusion ◽  
Off Pump ◽  
Early Graft ◽  
Secondary Outcomes ◽  
Pump Coronary Artery Bypass

Background. Decreased graft patency after off-pump coronary artery bypass grafting (OPCAB) leads to substantial increases in cardiac events. However, there is paucity of data on efficacy and safety of perioperative statin therapy for OPCAB populations. Methods. 582 patients undergoing OPCAB in a single-institution database (October 1, 2009–September 30, 2012) were stratified by perioperative continuation of statin therapy (CS group, n=398) or not (DS group, n=184). Inverse probability weighted propensity adjustment was used to account for treatment assignment bias, resulting in a well-matched cohort. Primary outcomes were graft patency at an average of five days after operation and in-hospital mortality. Secondary outcomes included intraoperative blood loss, liver, and renal functions. Results. No in-hospital death occurred in this study. Early graft patency rates after OPCAB were 98.4% (1255 of 1275 grafts) in the CS group and 98.0% (583 of 595 grafts, P=0.486) in the DS group. Secondary outcomes showed a reduction in blood loss during operation (438.53 mL versus 480.47 mL, P=0.01). Continuation of statin therapy is associated with alanine transaminase (ALT) elevation (49.67 U/L versus 34.52 U/L, P<0.001), as well as aspartate transaminase (33.54 U/L versus 28.10 U/L, P<0.001). Abnormal ALT elevation was observed in 8.9% of the CS group and 3.1% in DS (odds ratio 3.06, 95% confidence interval, 1.77 to 5.29, P<0.001). There was no significant difference in estimated glomerular filtration rate (76.28 mL/min/1.73m2 versus 76.13 mL/min/1.73m2, P=0.90). Subgroup analyses suggested that graft occlusion was less common in CS than in DS group among smoking patients (odds ratio 0.41, 95% confidence interval, 0.20 to 0.86, P=0.026). Conclusions. Perioperative continuation of statin therapy did not improve early graft patency in OPCAB patients. A lower risk of graft occlusion was observed among smoking patients. Continuous statin use correlated with liver function elevation (Clinical Trials.gov number, NCT 01268917).

scholarly journals ANGIOGRAPHIC EVALUATION OF GRAFT PATENCY AFTER MINIMALLY INVASIVE MULTIVESSEL CORONARY BYPASS SURGERY

2019 ◽  
Vol 178 (5) ◽  
pp. 57-61
Author(s):  
M. A. Snegirev ◽  
A. A. Paivin ◽  
D. O. Denisiuk ◽  
O. A. Drozdova ◽  
G. M. Mitusova ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Minimally Invasive ◽  
Radial Artery ◽  
Perioperative Complications ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Graft Patency ◽  
Perioperative Outcomes ◽  
Complete Revascularization ◽  
Off Pump

The OBJECTIVE was to demonstrate perioperative outcomes and angiographic graft patency rates in the mediumterm period in patients after multivessel minimally invasive coronary artery bypass grafting (MICS CABG) procedures.MATERIAL AND METHODS. In the period from 2014 to 2019, 270 patients with stable forms of coronary artery disease were operated on. All patients received left internal thoracic artery (LITA) and venous or arterial (radial artery) grafts. Off-pump surgery was performed in 264 cases (97.8 %). 127 patients underwent CT-bypass angiography (CT-BA) on a 128-slice computed tomography at least after 1 year after the operation. Mean follow-up duration was (30.3±7.9) months.RESULTS. All patients received full myocardial revascularization. Mean number of grafts was (2.6±0.5). Perioperative mortality rate was 0.4 % (1 patient). Perioperative myocardial infarctions or cerebrovascular accident occurred in 3 (1.1 %) and 1 (0.4 %) patients. Overall graft patency rate in examined patients was 89.8 % (290 of 323). At the time of LITA, the patency of mammary grafts was 98.4 % (124 of 126), venous graft –84.0 % (163 of 194) and radial artery grafts – 100 % (3 of 3).CONCLUSION. MICS CABG was safe and effective and was characterized by minimal rate of perioperative complications. This procedure allowed to achieve complete revascularization of the myocardium without sternotomy and could be performed off-pump (in most cases). MICS CABG provide excellent long-term graft patency rates.The authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information.

On-Pump Coronary Artery Bypass Graft: The State of the Art

2019 ◽  
Vol 14 (2) ◽  
pp. 106-115 ◽  
Author(s):  
Giovanni Cuminetti ◽  
Ivano Bonadei ◽  
Enrico Vizzardi ◽  
Edoardo Sciatti ◽  
Roberto Lorusso
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Radial Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Standard Of Care ◽  
Coronary Intervention ◽  
Diabetic Patients ◽  
Off Pump

Background:Coronary artery bypass grafting (CABG) remains the standard of care for patients with coronary artery disease (CAD). Debate exists concerning several factors, which include percutaneous coronary intervention (PCI) vs. CABG, single vs. bilateral mammary artery grafts, radial artery vs. saphenous vein grafts, right internal mammary artery vs. radial artery grafts, endoscopic vs. open vein-graft harvesting, and on-pump vs. off- pump surgery.:Moreover, challenging is the management of diabetic patients with CAD undergoing CABG. This review reports current indications, practice patterns, and outcomes of CABG.Methods:Randomized controlled trials comparing CABG to other therapeutical strategies for CAD were searched through MEDLINE, EMBASE, Cochrane databases, and proceedings of international meetings.Results:Large multicenter randomized and observational studies (SYNTAX, BEST, PRECOMBAT, ASCERT) have reported excellent outcomes in CABG patients, with always fewer rates of operative mortality and major morbidity, than PCI. The 10-year follow-up of ARTS II trial showed no difference between single and bilateral mammary artery. BARI 2D, MASS II, CARDia, FREEDOM trials showed that CABG is the best choice for diabetic patients.Conclusion:CABG still represents one of the most widespread major surgeries, with well-known benefits on symptoms and prognosis in patients with CAD. However, further studies and follow-up data are needed to validate these evidences.

Effect of Clopidogrel on Midterm Graft Patency following Off-Pump Coronary Revascularization Surgery

2006 ◽  
Vol 9 (6) ◽  
pp. E581-E856 ◽  
Author(s):  
Khalid Ibrahim ◽  
Ole Tjomsland ◽  
Dag Halvorsen ◽  
Rune Wiseth ◽  
Alexander Wahba ◽  
...  
Keyword(s):  
Coronary Revascularization ◽  
Graft Patency ◽  
Off Pump ◽  
Revascularization Surgery

Exclusive Bilateral Internal Thoracic Artery Grafts for Myocardial Revascularization Requiring Four Anastomoses or More: Outcomes from a Single Center Experience

2016 ◽  
Vol 65 (04) ◽  
pp. 265-271
Author(s):  
Andrea Perrotti ◽  
Enrica Dorigo ◽  
Camille Durst ◽  
Djamel Kaili ◽  
Sidney Chocron ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Internal Thoracic Artery ◽  
Artery Bypass ◽  
Univariate Analysis ◽  
Bypass Graft ◽  
Myocardial Revascularization ◽  
Wound Complication ◽  
Safe Procedure ◽  
Off Pump

Introduction Multivessel coronary artery bypass graft (CABG) with bilateral internal thoracic arteries (BITA) has only been uncommon and technically demanding. We describe our experience with BITA only CABGs requiring ≥ 4 anastomoses. Material and Methods The department's database was queried for patients undergoing isolated CABG with ≥ 4 anastomoses. The surgical technique included systematically a right internal thoracic artery (ITA) of left ITA Y graft. The multivariate model included variables with a p < 0.3 at univariate analysis. Results Between January 2006 and December 2009, 251 consecutive patients (71 ± 10 years) (on-pump: 130, off-pump: 121) had CABG with ≥ 4 anastomoses, representing 21% of total isolated CABGs for the same period; all patients received a totally arterial BITA only revascularization. Follow-up was 4.9 ± 1.6 years. Overall and cardiac cumulative survivals were 78 and 92%, respectively, at 5 years. The occurrence of any major postoperative complication was associated with overall and cardiac mortality (odds ratio [OR]: 3.6, 95% confidence interval [CI]: 1.3–9.9 and OR: 5.4, 95% CI: 1.3–21.9, respectively). Major sternal wound complication requiring surgical revision was not associated with impaired glucose control (n = 9; diabetics: 6/82, 7.3%; nondiabetics: 3/169, 1.8%, p = 0.06). Preoperative kidney failure was associated with incomplete revascularization (OR: 6.2; 95% CI: 1.2–33.5), that was unfailingly due to ungraftable right coronary artery targets. Discussion BITA only revascularization was a valuable and safe procedure, with favorable results in terms of morbidity and mortality at a 5 years' follow-up.

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